Author + information
- Angela L. Brennan,
- Nick Andrianopoulos,
- Stephen Duffy,
- Andrew E. Ajani,
- David Clark,
- Jeffrey Lefkovits,
- Alexander Black,
- Matthew Brooks,
- Bryan Yan,
- Gishel New,
- Philippa Loane,
- Louise Roberts and
- Christopher Reid
US guidelines recommend a door-to-balloon time (DTBT) of ≤90 minutes for patients presenting with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). System improvements to reduce DTBT were implemented across the period of this study and included regular peer-based review of results, reductions in system delay through electronic transmission of ECGs from the field and the bypassing of emergency departments.
We assessed temporal trends in DTBT from 2006–2010 in 1,921 STEMI PPCI's from the Melbourne Interventional Group registry, Australia. We excluded STEMI's presenting >12 hours, rescue PCI's and patients transferred from a non-PCI capable hospital.
The median (IQR) DTBT decreased from 95 (74 to 130) minutes in 2006 to 75 (51 to 100) minutes in 2010, p (for trend)<0.001, and the proportion of those achieving a DTBT of ≤90 minutes increased from 45% to 67%, p (for trend)<0.001 across the same period. Clinical presentation was similar across the years apart from an increase in those presenting following out-of-hospital cardiac arrest (OHCA), 3.6% to 9.4%, p (for trend)<0.001 or with cardiogenic shock (CS), 7.7% to 9.6%, p (for trend)=0.07. In-hospital, 30-day and 12-month mortality and MACE were all significantly worse when the DTBT exceeded 90 minutes (all p<0.001). Despite the decrease in overall DTBT, in-hospital and 30-day mortality and MACE tended to increase across the years. However, when OCHA and CS cases were excluded (n=292), any trend towards worse outcomes disappeared. No significant trend in symptom-to-door time (STDT) was observed across the years, nor was it associated with outcomes. Multivariate analysis showed a DTBT of ≤90 minutes was associated with improved survival at 12-months (OR 0.48; 95% CI: 0.33–0.73, p=0.001).
Our program of system improvements resulted in a decline in the median DTBT despite an increase in patients with OCHA and shock being treated. DTBT of ≤90 minutes is associated with improved outcomes at 30-days and 12-months. There remains room for improvement to achieve the recommendation that at least 75% of patients be treated with a DTBT of ≤90 minutes.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Percutaneous Coronary Intervention for AMI: Predictors of Outcome
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1216-209
- 2013 American College of Cardiology Foundation